Simply put, it is a defect in the abdominal wall. A normal abdominal wall is composed of muscles and fascia, but when there is neither muscle nor fascia, there is a hole. This allows for the intestine or abdominal organ to protrude through.
Hernia is usually caused by abdominal strain overtime or the weak area that may exist since birth. Although it usually occurs in the abdomen between the chest and hips, it can also appear in the upper thigh and groin areas. If not treated, hernias can worsen over time.
There are several types depending on their location.
Inguinal or Groin hernia
Inguinal hernias are the most common type, especially in men. They are located in the inguinal canal found in the groin and appears when the intestines push through a weak or tear in the abdominal wall. In men, it is found around the spermatic cord which holds the testicles. Whereas, in women, the inguinal canal contains a ligament that holds the uterus. An inguinal hernia occurs more commonly in men because the testicles fall towards the inguinal canal soon after birth. When the canal does not close as it should, it leaves a weakened area.
Umbilical hernia is an abnormal lump near the belly button. Even though it is more common in children, it can occur during adulthood as well. In children, this type of hernia goes away on its own as the abdominal walls get stronger. For more information on childhood Hernias treatment, please click here
Contrarily, in adults, an umbilical hernia can ensue from repeated strain on the abdomen mostly due to intense exercise, constipation, chronic coughing, pregnancy or obesity. More common in men, it can affect anyone in any age group and requires treatment.
It results from a weak area in the abdomen that allows for the tissues to bulge through an opening in the muscles. It is usually acquired during one’s lifetime, but can also be present from birth. Excessive activity, obesity, and pregnancy are common factors of ventral hernia formation. Surgery can also cause a ventral hernia which is then referred to as an incisional hernia.
There is a 15 to 20% chance of incisional hernias happening as a result of abdominal operations involving incisions. Like the name suggests, its a lump near the incision site.
It is best to consult a specialist if you experience any discomfort or pain. In the case where there were no symptoms, and the hernia is left untreated, the bowel could get stuck in the hole. This causes incarceration or strangulation which may lead to severe pain, requiring immediate medical attention.
Incarceration is when the intestine becomes trapped in a weak abdomen wall and cannot be pushed back. Strangulation is when there is swelling, creating a blockage of blood flow to the intestine.
Don't leave the hernia untreated until it you experience severe pain. Click here to make an appointment with doctor if you notice any symptoms.
Firstly, your doctor will perform a physical examination. If the hernia is obvious, then the doctor can see a bulge that goes away when the patient lies down. Then, the doctor will ask about your medical history as well as your lifestyle, including your exercise routine, and if you smoke. Your risks also depend on if you have had abdomen or groin surgery in the past, and your family history of hernias. In the case that the hernia isn’t prominent, your doctor will carry out an imaging test of either an abdominal ultrasound, CT scan, or MRI scan. This will aid the doctor with the diagnosis.
Inguinal, Umbilical, Ventral, and all other types of hernias including the lesser common ones can be repaired with an open surgery or a laparoscopic surgery. There are pros and cons to each treatment method, which may differ from case to case. Our doctor will share the details of which the patient, so they can make a well-informed choice for treatment.
We can keep the hernia in place with non-surgical approaches using a corset, truss, or binder to apply gentle pressure, and prevent future complications. Even then, the possibility remains, so it important to monitor the hernia.
The only effective way to cure a hernia is through a surgical repair, the purpose of which is to close the hole. It is important to choose a trusted and experienced general or laparoscopic surgeon and a medical facility well-equipped for these procedures.
Traditionally, tissue repair or just a stitch was used to keep the muscles together but this caused pain and the recurrent rate was approximately 5%. In the modern technique, we use a mesh or synthetic material to keep the hernia in place until it heals. The new tissue will incorporate the mesh to fix it with the muscle, allowing the mesh to prevent any protruding. Doctors have used mesh in hernia repair for over 2 decades, and the recurrent rate has been less than 1%.
Mesh was first introduced for open surgeries, but it is now also used in the newer technique, the laparoscopic or keyhole surgery. Here, the surgeon makes multiple small openings and fixes the hernia by inserting a small camera inside the body for location guidance. A larger mesh can be used for this procedure, making the hold stronger. Laparoscopic repair is a minimally invasive surgery, hence less painful.
In Samitivej, we use a 3D camera, allowing us to see in more detail and achieve superior results. To secure the mesh we use an absorbable tacker to lessen the chance of complications. Previously, metallic tackers were used, and in some medical facilities, it still is. Strangulate hernia that was once considered a complicated case, can now be treated by laparoscopic surgery with same success rate as other hernias.
Hernia treatments with an open surgery have a 95% success rate, while our laparoscopic surgery using 3D camera and mesh has 99%, with a recurrent rate of less than 1%.
We use biocompatible mesh reducing the chances of an allergic reaction significantly. Although hernia treatments are relatively safe, no surgery is risk-free. The open technique may result in pain around the nerves in less than 5% of cases. However, with laparoscopic repair, we can place the mesh away from the nerve, resulting in lesser risks.
The first two months is the healing period. During this time the tissue will grow and incorporate the mesh to fix the muscles, so it is best to avoid abdominal exercise or weight lifting to allow for complete healing. Basically, steer clear of any activity that puts pressure on the area or it could result in mesh displacement. Taking 1 week off of school or work is recommended.
Additionally, patients should
During this Covid-19 era, a 15-day Alternative Hospital Quarantine (AHQ) is required by the Thai government, before treatment can begin. After that, two days will be needed for treatment. It is advisable to stay one-week post-surgery, for a follow-up before flying back to your home country or you can opt for an online follow-up appointment via Samitivej Virtual Hospital, if your condition allows. In total, we recommend planning a stay in Thailand for a minimum of 3 and a half weeks.
Pakpong Wathanaoran, M.D. is a surgeon at Samitivej Sukhumvit Hospital with over 10 years experience in hernia repair, laparoscopic and abdominal surgeries. He has treated over 500 patients with hernia. Even with such experience, Dr. Pakpong continues to invest time in medical academia by participating in workshops and seminars such as ‘The 2nd Phuket International Symposium in Colorectal Disease, Bangkok Hospital Phuket’ and ‘D2 Gastrectomy, Upper GI Surgery Society of Thailand, Faculty of Medicine Siriraj Hospital’, amongst many others to stay up to date with the latest innovations in the field. To schedule an appointment with Dr. Pakpong, CLICK HERE
You can now consult with our doctor online via Samitivej Virtual Hospital before coming to the hospital. Click here to arrange VDO call with a doctor (subject to availability).
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